Name: Gift of Life Donation
Start: 2020-02-19T08:00:00-05:00
End: 2021-06-30T17:00:00-04:00

Name*
First Last
Email*
Enter Email Confirm Email
Preferred Phone Number*
Address*
Street Address Address Line 2 City State ZIP Code
Are you a Rotarian for a Friend of Rotary?*
- I am a Rotarian from District 7505
- I am a Rotarian from another District
- I am a Friend of Rotary
SELECT YOUR ROTARY CLUB!!!!!!!!!!!!!!!!!!!!!!!*
REQUIRED! Please select the Rotary Club in which you are a member.
Rotary District and Club Name required!*
I am a Friend of Rotary*
Tell of how you know of the District 7505 Gift of Life Foundation?
Donation Options*
Please select one of the options for your donation.
- General Fund
- In Memory of...
- In Honor of...
In Memory of...*
Please provide the name of the person with whom you would like the donation in memory.
In Honor of...*
Please provide the name of the person with whom you would like the donation in honor.
Donation Amount*
Method of Payment*
- Credit Card
- Check
Billing Address*
Street Address Address Line 2 City State ZIP Code
Credit Card*
Card Details
Cardholder Name
Please make your check payable to:
Rotary District 7505 Gift of Life Foundation

Mail check to:
Diane Rotondelli
21 Jumping Brook Drive
Lakewood, NJ 08701

Contact Information:
Cell: (732)740-7428
[email protected]

Gift of Life Donation

Details